Family and Couples Therapy Flashcards
General characteristics of family and couples therapy
Problems are seen as lying in the interaction of individuals/families, rather than in the individuals
Often manifests as one person having a problem ‘the patient’
Therapists have to avoid making the same assumption that it is about the individual
Commonly delivered by a team (one observing and guiding the therapist in the room)
How distinct are the different approaches to family and couples therapy?
The models sometimes overlap (particularly structural and strategic)
Work of Haley started as strategic work and moved to being structural
Therapists who devise the therapies are people and can end up rowing about trivial things (the systemic group broke in two - there are a lot of therapies out there and some of them look very similar)
Where can family and couples therapy be applied?
Families
Couples
Therapeutic settings
Workplaces
Most common in family therapy where the child is the ‘patient’ and in marriage counselling
Strategic approaches
Derived from Bateson’s (1956) concepts of how family systems become problematic (particular focus on circularity)
Based on the assumption that family problems emerge when the family tries to solve issues, but the solutions are faulty - communication becomes contradictory (words and expression do not agree)
So the family solutions become factors that maintain or worsen difficulties
Role of therapist in strategic approaches
Strategic therapists do not join the family - more external and prescriptive
Adopts a position of being active and directive
Plan is to break up the pathological interaction patterns (symptom removal as the family will develop more adaptively once the symptoms are alleviated
Not cosmetic surface-level changes
Aim for more fundamental, rule-level changes
Strategies in strategic approaches
Commenting on how people in the system deal with each other so that patterns become overt (you all talk at once but do not listen)
Disrupting interactive sequences that can lead to conflict (one person talks at a time instead of all talking across each other)
Reorganise the system to function differently (the family must eat one meal a day together)
Breaking repetitive negative cycles (stop going out for a drink when frustrated with your partner)
Structural approaches
Based on the assumption that family problems emerge when boundaries between members and their roles are not clear or appropriate
What do you tend to see when boundaries between members of a family are not clear
Hierarchical problems (grandparents overrule parents; children expected to take on adult roles)
Cross-generational alliances (mother and grandmother act as parents, excluding the father)
Pathological patterns in structural approaches
Enmeshment
Disengagement
Enmeshment
Boundaries between family members are unclear/diffuse
Disengagement
Boundaries are too rigid
What are structural approaches based on?
Most developed from Minuchin’s (1978) work on psychosomatic families
- Family issues driving and maintaining the development of problems with a physical element (e.g. asthma, anorexia nervosa)
Pathology lies within the family, not the individual (family structure tends to react against any effort by the ‘patient’ to become less ill
Aims of structural approaches
To create change by ‘getting into’ the family system and interrupting patterns
‘Joining’ the family in therapy
Treatment aims of structural therapy
Achieve a pattern of clear, appropriately flexibly boundaries between the parental subsystem, the child subsystem, and the world
Helping families reorganise so that
- Parents are in charge
- Boundaries are clear and flexible
- There are healthy patterns of interaction
Allows for growth in the individual and development in relationships (children’s roles change as they mature)
Therapy techniques in structural approaches
Getting the family to enact their intentions, rather than just describing them, to highlight the way those interactions cause problems
Breaking up patterns of interaction by siding with one family member and developing their power within the family
Increasing stress within the family to unbalance the system
Manipulating mood states by acting out family mood displays
Labelling, exaggerating or prescribing symptoms (showing the family what they are doing)
Aims to allow slow changes, rather than sudden leaps (slower compared to strategic therapy)
Systemic approaches
Based on the assumption that family problems emerge when the family makes errors of judgement about causality and truth
Palazzoli (1978) - based on the assumption that one cannot make people change but one can make the system unstable, so that it has to find a new way of resting to a stable point
Assumed that the new stable point will be less pathological and more open to change than the former one (cannot be any worse)
What do you tend to see in systemic approaches
Belief that ‘I am right; you are wrong’
Failure to recognise that our own actions have consequences that cause us problems
Action on the basis of unilateral control (‘I am in charge, and you do what I say’)
Therapist’s role in systemic therapy
Be neutral - no prescribing a better way of being, assume that the family will have a strong capacity to self-heal without being told how
Develop hypotheses about what is going wrong in the family system
Use circular questioning to get the family members to discuss their own perspective about what is happening in the family system
- What do they think others believe is happening?
- Provokes discussion within the family, to correct misconceptions
Techniques in systemic therapy
Prescribing change in everyday life (not concerned about whether homework is done, as the aim is to get the family to be aware of their interactive style)
Prescribing paradoxical work
- ‘As the family is clearly held together by your daughter being unhappy, we want the parents to carry on being as negative to everyone as possible, and the daughter to be as miserable as she can, as that is the best way that you all know how to function as a family’
- Makes the family aware of their style, and its impact
Heatherington et al. (2015)
Summarises the evidence regarding which of the approaches have strong, modest and weak evidence
Points out that some have almost no evidence
The missing evidence
Evidence tends to be patchy
Does a therapy that was developed for one disorder work for another?
Is the therapy delivered as a stand-alone treatment or as a module of a broader therapeutic programme
Moderators and mechanisms
- Who benefits?
- How does it work?
Current developments in family and couples therapy
Greater emphasis on behavioural approaches
Behavioural Couples Therapy
Family-Based Treatment for bulimia nervosa
Behavioural Couples Therapy
Particularly effective when one member of the couple is depressed
As effective as CBT (Bodenmann et al., 2008)
Family-Based Treatment for bulimia nervosa
More effective than CBT
- Le Grange et al. (2015)
Future developments
Pin down therapies
Understand the mechanisms
